For people diagnosed with obstructive sleep apnea (OSA), Continuous Positive Airway Pressure (CPAP) therapy is an established treatment used to help maintain an open airway during sleep.
If CPAP has been prescribed for you, using it according to your healthcare provider’s instructions is an important part of managing OSA.
When CPAP is not being used, the positive airway pressure that helps keep the airway open is no longer present. Research has shown that OSA-related breathing events can return relatively quickly after CPAP therapy is withdrawn, although the severity of symptoms and how noticeable they are can vary from person to person.[1]
This does not mean that missing one night will cause a heart attack, stroke, or another serious medical event. Rather, it means that the underlying obstructive sleep apnea may again be present while you sleep without therapy.
What May Happen When CPAP Is Interrupted?
CPAP provides positive airway pressure while the device is being used.
When therapy is interrupted, some people may experience a return of OSA-related breathing events and symptoms.
Breathing Events May Return
Without PAP therapy, the upper airway may again narrow or collapse during sleep, resulting in obstructive apneas and hypopneas.
How often these events occur depends on the individual and the severity of their OSA.
Blood Oxygen Levels May Change
Obstructive breathing events can be accompanied by intermittent reductions in blood oxygen levels.
The extent of these changes varies based on factors such as OSA severity, sleep stage, body position, and other medical conditions.
Sleep May Become More Fragmented
OSA-related breathing events can trigger brief arousals from sleep.
These repeated disruptions may interfere with normal sleep continuity and can contribute to daytime symptoms such as sleepiness or difficulty concentrating.
Snoring May Return
Snoring is common in people with obstructive sleep apnea, although not everyone with OSA snores.
For some CPAP users, snoring may return when therapy is not being used because the airway is no longer being supported by positive pressure.
Daytime Sleepiness and Alertness
Excessive daytime sleepiness is a common symptom of obstructive sleep apnea.
Research examining CPAP withdrawal has found that sleepiness and alertness may worsen when therapy is discontinued, although individual responses vary.[1,3]
OSA is also associated with an increased risk of motor vehicle crashes, particularly when excessive daytime sleepiness is present.
Observational research has found substantially lower crash rates among some drivers with OSA after CPAP treatment.[4]
If you are experiencing excessive sleepiness or have difficulty remaining alert, do not drive or operate dangerous equipment and contact your healthcare provider.
CPAP Interruption and Cardiovascular Effects
Obstructive sleep apnea is associated with intermittent reductions in oxygen levels, activation of the autonomic nervous system, and changes in cardiovascular function.
Controlled CPAP-withdrawal studies have found that several days to approximately two weeks without therapy can be associated with changes such as:
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Increased blood pressure
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Increased heart rate
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Increased sympathetic nervous system activity
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Return of OSA-related breathing events
These findings help demonstrate that OSA physiology can return when effective PAP therapy is withdrawn.
However, they should not be interpreted to mean that missing one night of CPAP will cause a heart attack, stroke, or other major cardiovascular event.
Individual cardiovascular risk depends on many factors, including age, OSA severity, blood pressure, existing cardiovascular disease, medications, and overall health.
Health Conditions Associated With Untreated OSA
Obstructive sleep apnea itself has been associated with a number of cardiovascular, metabolic, and other health conditions.
These associations are one reason diagnosing and appropriately managing OSA is important.
Cardiovascular Conditions
OSA has been associated with conditions including:
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High blood pressure
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Atrial fibrillation and other arrhythmias
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Coronary artery disease
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Heart failure
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Stroke
Having OSA does not mean that a person will develop any of these conditions.
Individual risk varies, and CPAP should not be described as guaranteeing prevention of heart attack, stroke, heart failure, or other cardiovascular conditions.
Type 2 Diabetes and Metabolic Health
OSA is also associated with insulin resistance, metabolic dysfunction, obesity, and Type 2 diabetes.[8]
The relationships among sleep apnea, body weight, glucose regulation, and other metabolic factors are complex.
If you have diabetes or another metabolic condition, continue following the treatment plan recommended by your healthcare provider.
Cognitive Function
Sleep-disordered breathing has also been associated with problems involving memory, attention, and executive function.[9]
Many factors can affect cognitive health, and OSA should not be considered the sole cause of cognitive symptoms.
Persistent changes in memory or concentration should be discussed with a healthcare professional.
Should I Stop Using CPAP If I Feel Fine?
Not without speaking with your healthcare provider.
OSA-related breathing events can occur without a person being aware of them, and feeling better does not necessarily mean the underlying condition has resolved.
If CPAP has been prescribed for you, use it according to your healthcare provider’s instructions whenever you sleep.
Do not stop therapy or change prescribed pressure settings on your own.
If you believe you may no longer need CPAP—for example, because of significant weight loss, surgery, or another major health change—talk with your healthcare provider about whether reevaluation or additional testing is appropriate.
Maintaining Your Prescribed Therapy Away From Home
Travel, camping, power outages, and other changes in routine can make CPAP use less convenient.
Planning ahead can make it easier to continue prescribed therapy when you are away from your usual setup.
Travel
A compact PAP device may be easier to pack and transport than a larger bedside system.
The Transcend Micro™ Auto CPAP is a compact PAP device designed to provide prescribed therapy in a portable form factor.
The Transcend Micro is FAA compliant for onboard aircraft use. Airline requirements vary, so always confirm current policies with the airline operating your flight before departure.
Portable Power
When standard electrical power is unavailable, a compatible battery may provide an independent power option.
The optional Transcend PowerAway™ Battery is designed for use with compatible Transcend PAP equipment.
Actual battery runtime varies based on factors including:
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Prescribed pressure
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Breathing patterns
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Environmental conditions
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Battery condition
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Accessories
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Device settings
Do not assume a battery will provide a specific number of nights or hours without confirming the manufacturer’s current specifications and your individual therapy requirements.
Camping and Off-Grid Use
For camping or other situations where conventional electrical power may not be available, a portable PAP device combined with an appropriate compatible battery can provide another way to take prescribed PAP therapy with you.
Always follow the device and battery manufacturer’s instructions.
What If I Accidentally Miss a Night?
If you accidentally miss a night of prescribed CPAP therapy, resume therapy according to your healthcare provider’s instructions.
Do not panic or assume that one missed night has caused permanent harm.
However, if you are repeatedly unable to use your CPAP, contact your healthcare or equipment provider so they can help identify the cause.
Common problems may include:
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Mask discomfort
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Air leaks
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Nasal or throat dryness
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Difficulty tolerating airflow
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Equipment problems
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Travel challenges
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Problems with power access
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Difficulty keeping the mask on during sleep
Addressing these issues can make prescribed therapy easier to use consistently.
Frequently Asked Questions
What happens if I stop using CPAP?
OSA-related breathing events and symptoms can return when CPAP is not being used.
How quickly and how noticeably this occurs varies from person to person.
If you are considering stopping prescribed therapy, talk with your healthcare provider first.
What happens if I don't use CPAP for one night?
Research suggests that OSA-related breathing events can return quickly after CPAP withdrawal.
Some people may also notice snoring, poorer sleep, or increased sleepiness, while others may not immediately notice a difference.
A single missed night should not be described as automatically causing a serious cardiovascular event.
Resume your prescribed therapy and contact your healthcare provider if interruptions are frequent or intentional.
How long can I safely go without CPAP?
There is no universal amount of time that can be considered appropriate for every patient to stop prescribed CPAP.
The appropriate treatment plan depends on your diagnosis, OSA severity, medical history, symptoms, and other clinical factors.
If CPAP has been prescribed for you, use it whenever you sleep according to your healthcare provider’s instructions.
Talk with your provider before intentionally discontinuing treatment.
Can I stop CPAP if my symptoms improve?
Symptom improvement does not necessarily mean that obstructive sleep apnea has resolved.
Do not stop prescribed CPAP without consulting your healthcare provider.
If your health, weight, symptoms, or circumstances have changed significantly, your provider can determine whether reevaluation is appropriate.
Is untreated sleep apnea associated with heart disease?
OSA is associated with several cardiovascular conditions, including hypertension, atrial fibrillation, coronary artery disease, heart failure, and stroke.
These are associations, and individual risk varies.
CPAP should not be considered a guarantee against cardiovascular disease.
Can a portable CPAP help me continue therapy while traveling?
A portable PAP device can make prescribed therapy easier to take with you when traveling.
The Transcend Micro is a compact, FAA-compliant Auto CPAP designed to provide prescribed PAP therapy in a portable form factor.
Always confirm airline requirements before travel and use the device according to your prescription and the current Transcend Micro User Manual.
Important Safety Information
The Transcend Micro provides positive airway pressure for the treatment of obstructive sleep apnea in adults weighing more than 66 pounds (30 kg).
In the United States, federal law restricts the device to sale by, or on the order of, a physician.
The Transcend Micro may not be appropriate for every patient.
Review your complete medical history with your healthcare provider before beginning PAP therapy.
Please refer to the current Transcend Micro User Manual for complete:
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Indications for use
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Contraindications
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Warnings
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Cautions
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Adverse effects
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Operating instructions
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Safety information
Do not change prescribed pressure settings or discontinue prescribed PAP therapy without consulting your healthcare provider.
Disclaimer
This article is provided for general informational and educational purposes only and is not intended to provide medical advice, diagnosis, or treatment or to replace the advice of a physician or other qualified healthcare professional. Individual responses to an interruption in CPAP therapy vary, and no particular symptom or health outcome can be predicted from a missed night or period of interrupted therapy.
If CPAP has been prescribed for you, use it according to your healthcare provider’s instructions. Do not start, stop, or modify prescribed PAP therapy or pressure settings without consulting your healthcare provider.
In the United States, federal law restricts the Transcend Micro to sale by, or on the order of, a physician. Please refer to the current Transcend Micro User Manual for indications for use, contraindications, warnings, cautions, adverse effects, operating instructions, and other important safety information.
References
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Kohler, M., et al. CPAP withdrawal research examining recurrence of obstructive sleep apnea and cardiovascular effects following temporary discontinuation of therapy.
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American Academy of Sleep Medicine. International Classification of Sleep Disorders – Third Edition (ICSD-3).
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Lal, C., et al. (2021). Neurocognitive Impairment in Obstructive Sleep Apnea. Sleep Medicine Clinics, 16(3), 477–486.
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Tregear, S., et al. Continuous Positive Airway Pressure Reduces Risk of Motor Vehicle Crash Among Drivers With Obstructive Sleep Apnea: Systematic Review and Meta-analysis.
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Mehra, R., et al. (2006). Association of Nocturnal Arrhythmias With Sleep-Disordered Breathing: The Sleep Heart Health Study. American Journal of Respiratory and Critical Care Medicine, 173(8), 910–916.
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American Heart Association. Scientific statement addressing obstructive sleep apnea and cardiovascular disease.
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Reutrakul, S., & Mokhlesi, B. (2017). Obstructive Sleep Apnea and Diabetes: A State-of-the-Art Review. Chest, 152(5), 1070–1086.
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An, J., et al. (2022). The Effect of Obstructive Sleep Apnea on Cognitive Function: A Systematic Review and Meta-analysis. Journal of Clinical Neurology, 18(1), 1–11.
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Transcend Inc. Transcend Micro User Manual. Refer to the current revision for official indications, contraindications, warnings, cautions, operating instructions, product specifications, and safety information.
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